Godwin Ikwuakam and Yannick Pierre Complaint

8/7/2019 Godwin Ikwuakam and Yannick Pierre Complaint

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if- ;-INTHEUNITED STATES DISTRICT COURTFORTHE1il APR -7 2011EASTERN DISTRICT OF VIRGINIA \ l( .'.Ll:-' ,n Alexandria Division "

UNITED STATES OF AMERICA Case No. 1:11-MJ- o&l/-v. )YANNICK PIERRE, andGODWIN 0. IKWUAKAM,

Defendants.

AFFIDAVIT IN SUPPORT OF COMPLAINT AND SUMMONSI,MariaLitkenhus, being dully sworn, state:1. Iama special agent oftheFederal Bureau of Investigation and have been so

employed since April 2006. I am assigned to the Washington Field Office, Northern VirginiaResident Agency, and I am currently assigned to awhite collar crime squad specializing in healthcare fraud investigations. By virtue ofmy training and experience as a special agent, Iamfamiliarwith investigations involving individuals whoexecute fraudulent schemes.

2. This Affidavit is submitted in support ofa criminal complaint charging GODWINO. IKWUAKAM ("IKWUAKAM") and YANNICK PIERRE ("PIERRE") with Health CareFraud,in violationof 18U.S.C. 1347.

3. The facts and information contained in this affidavit are based upon my personalknowledge ofthe investigation aswell as theobservations ofotherlaw enforcement officersinvolved in this investigation, derived from, among other things, interviews with Medicaidrecipients and/or their caregivers. All observations that were not personally made byme wererelated to me by the person(s)who made such observations.

Case 1:11-mj-00284-TRJ Document 3 Filed 04/07/11 Page 1 of 25


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health aide services include assisting with personal hygiene, eating, walking, meal preparation,feeding, and taking and recording blood pressure, pulse, and respiration.

8. Home health agencies also provide private duty nursing, i.e., skilled, in-homenursing care provided by a registered nurse or a licensed practical nurse under the supervision ofa registered nurse. These services are rendered according toa plan of care, which enables theindividual to remain athome rather than ina hospital ornursing facility.

9. DMAS reimburses providers forthe amount oftimethatservice is provided.DMAS reimburses for unitsof servicethat correlate to a periodof time. One unit of service isequal to one hour of service.

10. According to the DMAS Elderlyor Disabledwith Consumer DirectionWaiverServices ProviderManual, the required documentation for individual records for agency-directedpersonal and/orrespitecare services includes provider attendantrecords reported on a formknown as theDMAS-90. Theproviderattendant records mustdocumentthecare givenand thetimes of arrival to, and departure, from the individual's home each day the attendant rendersservice. The provider attendant record must be thoroughlycompleted. The attendant and theindividualmust sign the records weekly. The attendants' weekly comments should notesignificant physical, social, and emotional aspectsof the individual's life that week. Theprovider attendant record is the document that DMASaccepts as proof that serviceswererendered. The provider attendant record forms must be in the individual's record within twoweeks.

11. According to the DMAS Home Health Manual, home health aide services ofpersonal and/orrespite caremust be provided underthe supervision of a registered nurseorlicensed therapist. When onlyhome health aide services arebeing furnished, a registered nurse

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must make a supervisory visit to the participant's residence at least once every 60days when theaide is furnishing care. The supervisory visit isnot reimbursable by the Medicaid program.

12. According to the DMAS Technology Assisted Waiver and Private Duty NursingServices Manual, the Medicaid criteria for general reimbursement ofPrivate Duty Nursingservices include a signed and dated physician order, a planof careandassessment, anddocumentation available for services rendered and billed. The nursing documentation requiredbyDMAS forprivate duty nursing services consists ofthe following: daily nursing log, thenursing staffmembers providing direct care are responsible for recording in a daily nursing logthenumber of hours of service provided. Services not specifically documented in the recipient'srecord as having been rendered areconsidered notto have been rendered, andany inappropriatepayment may be recovered by DMAS. The DMAS Manual also states that DMAS willreimburse for a maximum of 16hoursper24-hourperiodperhouseholdfor private duty nursing.

13. Ingeneral, to obtain reimbursement for healthcareservices, the participating

provider mustsubmit bills, or claims, to thepatient's insurance carrier. Theymaybeelectronicclaimssentbywireor paperclaimssent bymail. Electronic claimsare imaged andpaperclaimsprinted onto a CMS1500form that typically containsthepatient's name, date of birth, insurancecompany member number, service rendered (CPT Code - "Common Procedural Terminology"and/or HCPCS Code - "Healthcare Common Procedure Coding System"), provider's name, andassociated service charge. Oncethe claimhas beenreceived bythe insurance carrier, it isprocessed. After the claim has been approved, a check for the service is sent to the insured orprovider.



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FIRST CALL

14. InMarch 2008, IKWUAKAM signed a Personal Care Participation Agreement toparticipate in the DMAS Medical Assistance Program for Home and Community Based CareServices, under company name FIRST CALL HOME HEALTH ("FIRST CALL"). In June2008, IKWUAKAM signed a Private Duty Nursing Participation Agreement to participate in theDMAS Medical Assistance Program for Home andCommunity BasedCareServices.

15. An investigatorwith the VirginiaDepartment ofTaxation informedme thatIKWUAKAMandPIERREare responsiblefor the dayto daymanagementand finances ofFIRST CALL. The investigator informed me that IKWUAKAM stated that PIERRE controlledthe insurancebillings,filled out the paperwork, kept theofficeorganized, andknewtheofficeoperations. FIRST CALLemployed PIERREas an officemanager/clerk.

16. During a DMAS audit of FIRSTCALL in January2010, the following billingerrorswere found: themedical record(s) didnot containthe required DailyNursingLogforthedatesbilledand/orthe hoursbilleddidnotmatchthe documentation in the recipient record,required signatures of caregivers, recipients, andnursesweremissingor inappropriately datedonthe nursing notes for the dates billed; and the medical record indicated that the hours billed wereover the allowable 16 hours a day.

17. On or about May 19,2010,1 interviewed PIERRE. PIERRE told me that theinsurancebillingwas neverdone the way it was supposedto be done. JOSEPHINE OWUSU("OWUSU") wasemployed at FIRST CALL to keyin theentries into theVirginia Medicaidelectronic billing system onthe computer. OWUSU would billthe amount of hours the recipientwas approved for rather than the actual hours the aides provided care. PIERREand OWUSUwould contact IKWUAKAMwhen they did not knowwhat hours to bill, and IKWUAKAM

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a. My review ofDMASbillings for VERONICAP. for respite care servicesduring the same time period shows that FIRST CALL billed DMAS for 86hours. FIRST CALL'S DMAS-90 records, however, show that no serviceswere provided during that time period.

b. The total amountof false billings relatedto VERONICA P. during thesame time period for respite care services is $1,269.36. I conclude thatFIRSTCALLsubmitteda false and fraudulentbill to DMAS, resultingin anoverpayment by DMAS to FIRST CALL.

26. On April 24,2009, FIRST CALL billed, and received reimbursement, for HCPCST1002registered nursing care services duringthe periodApril 13,2009 through April 19,2009forKathleenC, patient identification number -3016, in theamount of$2,075.20by remittanceadvice number 8469461 dated May 1,2009.

a. My review ofDMASbilling for KathleenC. for RN servicesduring thesame time period shows that FIRST CALL billed DMAS for 80 hours.FIRSTCALL'S records, however, showthat only 55 hourswereprovidedduring that time period.

b. The total amount of false billings related to Kathleen C. during the sametime period for registered nursing care services is $648.50. I concludethatFIRSTCALLsubmitted a false and fraudulent bill to DMAS, resulting in anoverpayment by DMAS to FIRST CALL.

27. On April 24,2009, FIRST CALL billed, and received reimbursement for, HCPCST1003 licensed nursing care services during the period April 13, 2009 through April 19,2009for

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Kathleen C, patient identification number -3016, in the amount of $1,801.60 byremittanceadvice number 8469461 dated May 1,2009.

a. My reviewofDMAS billingfor Kathleen C. forLPNservices during thesame time period shows that FIRST CALL billedDMAS for 80 hours.FIRSTCALL'S records, however, showthat only 51 hourswereprovidedduring that time period.

b. The total amount of false billings related to Kathleen C. during the sametime period for LPN services is $653.08. I conclude that FIRST CALLsubmitted false and fraudulent bills to DMAS, resulting in an overpaymentby DMAS to FIRST CALL.

28. On December 4,2009, FIRST CALL billed, and received reimbursement, forHCPCS T1003 licensed practical nurse services during the period November 23,2009 throughNovember 29,2009 for Naem S., patient identification number -7011, in the amount of$1,911.00 by remittance advice number 8871276 dated December 11,2009.

a. My review ofDMAS billings for Naem S. for LPN services during thesame time period shows that FIRST CALL billed DMAS for 70 hours.FIRST CALL'S record, however, show that only 55.5 hours were providedduring that time period.

b. The total amount of false billings related to Naem S. during the same timeperiod for LPN services is $395.85. I conclude that FIRST CALL submitteda false and fraudulent bill to DMAS, resulting in an overpayment by DMASto FIRST CALL.



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forGLENDA R., patientidentification number -2018, in the amountof $425.60 by remittanceadvice number 8993373 dated February 19,2010;

a. My review ofDMAS billings for Glenda R. for respite care servicesduring the same time period shows that FIRST CALL billed DMAS for 28hours. FIRST CALL'SDMAS-90 records, however, show that only 20 hourswere provided during that time period. (A second, unsigned DMAS-90 forthe same time period, which was found during the execution of a searchwarrant at FIRST CALL'S premises, claimed 28 hours of care was provided.)

b. The total amount of false billings related to Glenda R. during the sametime period for person care and respite services is $364.80. I conclude thatFIRST CALL submitted false and fraudulent bills to DMAS, resulting in anoverpayment by DMAS to FIRST CALL.

33. On May 9,2009, FIRST CALL billed, and received reimbursement, for HCPCST1002 registered nursing care services during the period May 1, 2009 through May 3,2009 forKathleenC, patient identification number -3016, in the amountof $1,341.12 [billing]byremittance advice number 8494456 dated May 15,2009. FIRST CALL was reimbursed$1,245.12;

34. On May 15, 2009, FIRST CALL billed, and received reimbursement for, HCPCST1002 registered nursing care services during the period May 4,2009 through May 10,2009 forKathleenC, patient identification number -3016, in the amountof $3,129.28 [billing] byremittance advice number 8507577 dated May 22, 2009. FIRST CALL was reimbursed$2,905.28;

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35. On May 22,2009, FIRST CALL billed, and received reimbursement, for HCPCST1002 registered nursing care services during the period May 11,2009 through May 17, 2009 forKathleen C, patient identification number -3016, in the amount of $3,129.28 [billing] byremittance advice number 8519608 dated May 29,2009. FIRST CALL was reimbursed$2,905.28;

36. On May 29, 2009, FIRST CALL billed, and received reimbursement, for HCPCST1002 registered nursing care services during the period May 18, 2009 through May 24,2009 forKathleenC, patient identification number -3016 in the amount of$2,905.28 by remittanceadvice number 8534468 dated June 5,2009;

37. On June 5,2009, FIRST CALL billed, and received reimbursement, for HCPCST1002 registerednursing care services during the periodMay 25,2009 through May31,2009 forKathleenC, patient identification number -3016 in theamountof $2,905.28by remittanceadvice number 8546145 dated June 12,2009;

38. My review ofDMASbillings for KathleenC. for RN services during the sametime periodofMay 1-31, 2009, shows that FIRSTCALLbilled DMAS for 496 hours. FIRSTCALL'S records, however, show that only 197.5 RN service hours were provided during thattime period. During the execution of the searchwarrant, agents located records from the sametime period that claimed 266.5 hours of LPN serviceswere provided. FIRST CALLdid not billDMAS for LPN services for that time period but instead billed for RN services, which DMASreimburses at a higher rate.

39. The total amount of false billings related to Kathleen C. during the same timeperiod ofMay 1-31,2009 for RN services is $8,062.60. I conclude that FIRST CALLsubmittedfalse and fraudulent bills to DMAS, resulting in an overpayment by DMAS to FIRST CALL.

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40. On June 26, 2009, FIRST CALL billed, and received reimbursement, for HCPCST1019 personal care services during the period June 15, 2009 through June 21,2009 for BurtonH., patient identificationnumber -6013, in the amount of $280.44 by remittance advicenumber8571954 dated July 3,2009;

41. On July 3,2009, FIRST CALL billed, and received reimbursement, for HCPCST1019 personal care services during the period June 22,2009 through June 28,2009 for BurtonH., patient identification number -6013, in the amount of $280.44 by remittance advice number8589564 dated July 10,2009;

42. On July 10,2009, FIRST CALL billed, and received reimbursement, for HCPCST1019 personal care services during the period June 29,2009 through June 30,2009 forBURTON H., patient identification number -6013, in the amount of $88.56 by remittance advicenumber 8602413 dated July 17,2009;

43. On July 10,2009, FIRST CALL billed, and received reimbursement, for HCPCST1019 personal care services during the period July 1,2009 through July 5,2009 for Burton H.,patient identification number -6013, in the amount of $197.60 by remittance advice number8602413 dated July 17,2009;

44. On July 17,2009, FIRST CALL billed, and received reimbursement, for HCPCST1019 personal care services during the period July 06, 2009 through July 12, 2009 for BurtonH., patient identification number -6013 in the amount of $288.80 by remittance advice number8614427 dated July 24,2009;

45. My review ofDMAS billings for Burton H. for personal care services during theperiod of June 15,2009 through July 12, 2009 revealed that FIRST CALL billed DMAS for 76hours. My review ofBurton H. Certificate ofDeath obtained from the Commonwealth of

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Virginia,DepartmentofHeath, Division ofVital Records, revealed that BurtonH. died onMay31,2009.

46. My review of FIRST CALL's DMAS-90 records revealed that 76 hours of carewere provided during the same time period. These forms, however,were not signedbytherecipient or a responsible family member and the aide.

47. The total amount of false billings related to Burton H. during the same timeperiod, June 15,2009 through July 12,2009 for personal care services is $1,135.84. I concludethat FIRST CALLsubmitted false and fraudulent bills to DMAS, resulting in an overpaymentbyDMAS to FIRST CALL.

48. On October 9, 2009, FIRST CALLbilled for HCPCS Tl003 licensed practicalnurse services during the period September 21, 2009 through September 27,2009 for Joseph D.,patient identification number -6019, in the amountof$1,965.60 by remittance advice number8768938 dated October 16,2009.

49. On October 3,2009, FIRST CALL billed for HCPCS T1003 licensed practicalnurse servicesduring the periodof September21, 2009 throughSeptember27, 2009 for JosephD., patient identification number -6019, in the amountof$4,586.40 [billing] by remittanceadvice number 8758697 dated October 9,2009. FIRST CALL was reimbursed $3,783.36.

50. My review ofDMASbillings for Joseph D. for LPN services during the sametime period reveals that FIRST CALLbilled DMAS for 168 hours ofLPN services on October 3,2009 and for72hours onOctober 10,2009. FIRST CALL'S records, however, show thatonly93.75 hours were provided during that time period. During the execution of the search warrant,agents located records from the sametime period that claimed72 hoursof carewasprovided.

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These forms, however, were not signed by the recipient or a responsible family member and theaide.

51. On April 16,2010, an investigator with the Virginia Office of the AttorneyGeneral ("OAG") interviewed Joseph D.'s father. The investigator told me that Joseph D.received approximately 60 hours of services per week.

52. The total amount of false billings related to Joseph D. during the same period ofSeptember 21-27,2009 is $3,992.63. I conclude that FIRST CALL submitted false andfraudulent bills to DMAS, resulting in an overpayment by DMAS to FIRST CALL.

53. On July 24,2009, FIRST CALL billed, and received reimbursement, for HCPCST1019 personal care services during the period June 22,2009 through June 30,2009 for MichelleP., patient identification number -3013, in the amount of $1,062.72 by remittance advice number8629457 dated July 31,2009;

54. My review ofDMAS billings for Michelle P. for personal care services during the

same time period shows that FIRST CALL billed DMAS for 72 hours. FIRST CALL'SDMAS-90 records, however, show that only 47 hours were provided during that time period.Additionally, located during the search was another DMAS-90 for the same time period, whichclaimed 60 hours of care was provided, however this form was not signed by the recipient or aresponsible family member and the aide.

55. On July 24, 2009, FIRST CALL billed, and received reimbursement, for HCPCST1005 respite care services during the period June 22, 2009 through June 30, 2009 for MichelleP., patient identification number -3013 in the amount of$885.60 by remittance advice number8629457 dated July 31, 2009;

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56. My review ofDMAS billings for Michelle P. for respite care services during thesame time period shows that FIRST CALL billed DMAS for 60 hours. DMAS-90 recordsobtainedduringa searchwarrant at FIRSTCALL, showthat no hours wereprovidedduringthes ame t ime frame.

57. On April 13,2009,1 interviewed Michelle P. Michelle P. told me that theyreceive approximately 56 hours of care a week from FIRST CALL.

58. The total amount of false billings related to Michelle P. during the same timeperiod of June 22-30,2009 for personal care and respite care services is $1,254.60. I concludethat FIRST CALLsubmitted false and fraudulentbills to DMAS, resulting in an overpaymentbyDMAS to FIRST CALL.

59. On August 7,2009, FIRST CALL billed, and received reimbursement, forHCPCS T1019 personal care services during the period July 27, 2009 through July 31, 2009 forChristopherO., patient identification number -6061 in the amount of $456.00 by remittanceadvice number 8654458 dated August 14,2009;

60. My review ofDMAS billings for Christopher O. for personal care services duringthe same time period shows that FIRST CALL billed DMAS for 30 hours. DMAS-90 recordsobtained during a search warrant at FIRST CALL, show that 12 hours were provided during thesame time frame. Additionally, located during the search was another DMAS-90 for the sametimeperiod, which claimed 30 hours of carewasprovided, however this form was not signed bythe recipient or a responsible family member and the aide.

61. On August 7,2009, FIRST CALL billed, and received reimbursement, forHCPCS T1005respitecare servicesduringtheperiodJuly27, 2009 throughJuly31,2009 for

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CHRISTOPHER 0., patient identification number -6061 in the amount of $304.00 by remittanceadvice number 8654458 dated August 14, 2009;

62. My review ofDMAS billing for Christopher O. for respite care services during thesame time period shows that FIRST CALL billed DMAS for 20 hours. FIRST CALL'S DMAS-90 records, however, show that only no hours were provided during the same time frame. Duringthe execution of the search warrant, agents located another DMAS-90 for the same time periodthat claimed 20 hours of care was provided. This form, however, was not signed by recipient ora responsible family member and the aide.

63. On March 10, 2010 and May 10, 2010,1 interviewed SONIA O., CHRISTOPHERO.'s mother. Sonia O. told me that Christopher O. received between 28 and 32 hours per week inservices. She told me that IKWUAKAM wanted her to sign several DMAS-90 records that hadincorrect times on them, but she refused to do so because the hours did not match the actualhours ofcare that the aide provided. The DMAS-90's presented to her included additionalhoursthat had not been provided.

64. The total amount of false billings related to Christopher O. during the period ofJuly 27-31,2009 for personal care and respite care services is $577.60. I conclude that FIRSTCALLsubmitted falseand fraudulent bills to DMAS, resulting in an overpayment byDMAStoFIRST CALL.

65. On September 11,2009, FIRST CALL billed, and received reimbursement, forHCPCST1019personal care servicesduringthe periodSeptember1,2009 throughSeptember6,2009 for Veronica P., patient identification number -7470, in the amount of $486.40 byremittanceadvice number 8718529 dated September 18,2009;

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66. On September 18,2009, FIRST CALL billed, and received reimbursement, forHCPCS T1019 personal care services during the period September 7, 2009 through September13,2009 for VeronicaP., patient identification number -7470, in the amount of $486.40byremittance advice number 8732031 dated September 25,2009;

67. On September 25,2009, FIRST CALL billed, and received reimbursement, forHCPCS Tl 019 personal care services during the period September 14, 2009 through September20,2009 for Veronica P., patient identification number -7470, in the amount of $608.00 byremittance advice number 8745653 dated October 2,2009;

68. On October 2,2009, FIRST CALL billed, and received reimbursement, forHCPCST1019 personal care services during the period September 21,2009 through September27,2009 for VeronicaP., patient identification number -7470, in the amount of $608.00byremittance advice number 8758697 dated October 9,2009;

69. On October 9,2009, FIRST CALL billed, and received reimbursement, forHCPCS T1019 personal care services during the period September 28,2009 through September30,2009 forVeronica P., patient identification number -7470, in the amountof $364.80 byremittance advice number 8768938 dated October 16, 2009;

70. My reviewof DMAS billings forVeronica P. for personal care services during themonth of September 2009 shows that FIRST CALL billed DMAS for 168 hours. FIRST CALL'SDMAS-90 records, however, show that only 128hourswereprovided duringthat time period.

71. OnJuly20,2010 anOAG investigator interviewed Veronica P. The investigatortold me that Veronica P. confirmed that the signature on some of the assessment forms was nothers and that Veronica P. signs all her DMAS-90 records and assessment forms herself. Theinvestigator toldmethatVeronica P. provided thatPIERRE called her asking herto re-sign

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DMAS-90 records because of corrections that needed to bemade. Veronica P. did not signthecorrected DMAS-90 records. Veronica P. said thatheraidewasasked to re-sign approximately15DMAS-90 records. Veronica P. attended a funeral in Connecticut in September 2009 foroneweek and did not receive any service from FIRST CALLduring that time.

72. The total amount of false billings related to Veronica P. during the same timeperiod ofSeptember 2009 for personal care services is $608.00. I conclude that FIRST CALLsubmitted falseand fraudulent bills to DMAS, resulting in an overpayment byDMAS to FIRSTCALL.

73. On September 25,2009, FIRST CALL billed, and received reimbursement, forHCPCS T1003 licensedpractical nurse services during the period August 5, 2009 throughAugust 31,2009 for Joseph D., patient identification number -6019, in the amount of $17,690.40[billing] by remittance advice number 8745653 dated October 2, 2009. FIRST CALL wasreimbursed $14,592.96;

74. My review ofDMAS billings for Joseph D. for LPN services during the sametime period revealed that FIRST CALL billed DMAS for 648 hours. FIRST CALL'S records,however, show that only 540.75 hours were provided during that time period.

75. On April 16,2010, an OAG investigator interviewed Joseph D.'s father. Theinvestigator toldme that JosephD. received approximately 60 hoursof services perweek.

76. The total amount of false billings related to Joseph D. during the time period ofAugust 5-31,2009 for LPN services is $2,927.93. I conclude that FIRST CALL submitted afalse and fraudulentbill to DMAS, resulting in an overpayment byDMAS to FIRSTCALL.

77. On September 25,2009, FIRST CALL billed, and received reimbursement, forHCPCS T1003 licensed practical nurse services during the period September 1,2009 through

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September20,2009 for JosephD., patient identification number -6019, in the amountof$13,104.00 [billing] by remittance advicenumber 8745653 datedOctober2,2009. FIRSTCALL was reimbursed $10,809.60;

78. My review ofDMAS billings for Joseph D.for LPN services during the sametime periodshows that FIRSTCALLbilledDMAS for 480 hours. FIRSTCALL'S records,however, showthat only336hourswere provided duringthat timeperiod.

79. The total amount of false billings related to Joseph D.during the time period ofSeptember 1-20,2009 for LPN services is $3,931.20. I conclude that FIRST CALL submittedfalse and fraudulent bills to DMAS, resulting in an overpayment byDMASto FIRSTCALL.

80. On November 15,2008, FIRSTCALL billed, and received reimbursement, forHCPCS T1019personal care services duringthe period September 19,2008 through September30,2008 for Veronica P., patient identification number -7470, in the amount of $1,461.24 byremittance advice number 8163836 dated November 21,2008;

81. My reviewof DMAS billingsforVeronica P. forpersonal care services during thesame time period shows that FIRST CALL billed DMAS for 99 hours. FIRST CALL'S DMAS-90 records, however, showthat only56 hourswereprovided duringthe sametime frame.

82. The total amountof false billings related toVeronica P. duringthe sametimeperiod of September 19-30,2008 for personal care services is $634.68. I conclude that FIRSTCALL submitted a false and fraudulent bill toDMAS, resulting inan overpayment by DMAS toFIRST CALL.

83. On November 26,2009, FIRST CALL billed, and received reimbursement, forHCPCS T1019 personal care services during theperiod November 16,2009 through November

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22,2009 forMichelle P., patient identification number -3013, in the amount of $456.00 byremittanceadvice number 8860189 dated December4,2009;

84. My review ofDMAS billings forMichelle P. forpersonal care services during thesame time period shows that FIRST CALL billed DMAS for 30 hours. FIRST CALL'S DMAS-90 records, however, show thatonly 16hours were provided during the same time frame. Duringthe executionof the searchwarrant, agents located another DMAS -90 record for the same timeperiod thatclaimed 30 hours of care were provided. This form, however, was not signed bytherecipient or a responsible family member and the aide.

85. On November 26,2009, FIRST CALL billed, and received reimbursement, forHCPCS T1005respitecare services duringthe periodNovember 16,2009 through November 22,2009 forMichelleP., patient identification number-3013 in the amountof$699.20by remittanceadvice number 8860189 dated December 4,2009;

86. My review ofDMAS billings for Michelle P. for respite care services during thesame time period shows that FIRST CALL billed DMAS for 46 hours. FIRST CALL'S DMAS-90 records, however, show that no hours were providedduring the same time frame. Duringtheexecution of the search warrant, agents located another DMAS-90 for the sametimeperiod thatclaimed 46 hoursof carewereprovided. This form, however, was not signedby anyone.

87. The total amount of false billingsrelated toMichelle P. during the sametimeperiod ofNovember 16-22,2009 for personalcare and respite care services is $912.00. Iconclude that FIRSTCALL submitted false and fraudulent bills to DMAS, resulting in anoverpayment by DMAS to FIRST CALL.

88. On December 25,2009, FIRST CALL billed, and received reimbursement, forHCPCST1019personalcare services duringthe periodDecember 14,2009 throughDecember

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20,2009 for ERIC P., patient identification number -0017, in the amount of $456.00 byremittance advicenumber8910309 datedJanuary 1,2010;

89. My review ofDMAS billings for Eric P. for personal care services during thesame time period shows that FIRST CALL billed DMAS for 30 hours. FIRST CALL'S DMAS-90 records, however, show thatonly 25 hours were provided during the same time frame.Additionally, located during thesearch was another DMAS-90 forthe same time period, whichclaimed 30hours ofcare was provided, however this form was notsigned by the recipient oraresponsible family member and the aide.

90. On December 25, 2009, FIRST CALL billed, and received reimbursement, forHCPCS T1005 respite care servicesduring the periodDecember 14, 2009 throughDecember20,2009 forEric P., patient identification number -0017in theamountof $699.20 by remittanceadvice number 8910309 dated January 1, 2010;

91. My review ofDMAS billing for Eric P. for respite care services duringthe sametime period show that FIRST CALL billed DMAS for 46 hours. FIRST CALL'S DMAS-90records, however, showthat onlyno hourswere provided duringthe same time period.

92. On August 18,2009,1 interviewed Anna P., Eric P.'s mother. Anna P. told methat EricP. received approximately 20 hours of careperweek between themonths ofApril andDecember. Anna P. stated that the signature on some of the assessment forms was not hers.

93. The total amount of false billings related to Eric P. during the same time period ofDecember 12-20,2009 for personal care and respite care services is $775.20. I concludethatFIRST CALL submitted false and fraudulent bills toDMAS, resulting inan overpayment byDMAS t o F IRST CALL.

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94. On January 29,2010, FIRST CALL billed, and received reimbursement, forHCPCS T1019 personal care services during the period January 18, 2010 through January 24,2010 for Glenda R., patient identification number -2018, in the amount of$851.20 by remittanceadvicenumber8969281 datedFebruary 5,2010;

95. My review ofDMAS billings for Glenda R. for personal care services during thesame time period shows that FIRST CALL billed DMAS for 56 hours. FIRST CALL'S DMAS-90 records, however, show that only 40 hours were provided during the same time frame. Duringthe execution of the search, agents located another DMAS-90 for the same time period thatclaimed 56 hours of care was provided. This form, however, was not signed by the aide.

96. OnJanuary29,2010, FIRSTCALLbilled, and receivedreimbursement, forHCPCS T1005 respite care services during the period January 18,2010 through January 24, 2010for Glenda R., patient identification number -2018, in the amount of$425.60 by remittanceadvice number 8969281 dated February5, 2010;

97. My review ofDMAS billings forGlenda R. for respite care services during thesame time period shows that FIRST CALL billed DMAS for 28 hours. FIRST CALL'S DMAS-90 records, however, show that only 20 hours were provided during the same time frame. Duringthe execution of the search warrant, agents located another DMAS-90 for the same time periodthat claimed 28 hours of care were provided. This form, however, was notsigned by the aide.

98. The total amount of false billings related toGlenda R. during thesame timeperiod of January 18-24,2010 forpersonal care andrespite care services is $364.80. I concludethat FIRST CALL submitted false and fraudulent bills to DMAS, resulting inan overpayment byDMAS to FIRST CALL.

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99. OnMarch 19,2010,FIRST CALL billed, and received reimbursement, forHCPCS T1002 registered nursing care services during the period March 8,2010 through March14,2010 for Kathleen C, patient identification number -3016 in the amount of$2,075.20 byremittanceadvicenumber 9055642 dated March 26, 2010;

100. My review ofDMAS billings for Kathleen C. for RN services during the sametime period shows that FIRST CALL billed DMAS for 80hours. FIRST CALL'S records,however, showthatonly50 hours wereprovided during the same time frame.

101. The total amount of false billings related toKathleen C. during the same timeperiod of 3/8/2010 through 3/14/2010 for RN services is $778.20. I conclude that FIRST CALLsubmitted a false and fraudulent bill toDMAS, resulting inan overpayment byDMAS toFIRSTCALL.

CONCLUSION

102. Based uponthe foregoing, there is probablecause to believe that between oraround January 2008 andJune2010, in the Eastern District ofVirginia andelsewhere,IKWUAKAM andPIERRE knowingly and willfully executed, andattempted to execute, ascheme and artifice to defraud any health care benefit program, and to obtain, by means of falseor fraudulent pretenses, representation, orpromises, any of the money orproperty owned by, andunder the custody andcontrol of,anyhealth care benefit program, in violation of 18U.S.C.1347 (Health Care Fraud).

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Godwin Ikwuakam and Yannick Pierre Complaint